


Unexpected Outcomes

by julia_wicker_the_goddess



Category: Alexa & Katie (TV)
Genre: Hurt/Comfort, Leukemia, Medical Trauma
Language: English
Status: In-Progress
Published: 2020-10-25
Updated: 2020-12-29
Packaged: 2021-03-09 06:35:13
Rating: General Audiences
Warnings: No Archive Warnings Apply
Chapters: 4
Words: 7,047
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/27199261
Author URL: https://archiveofourown.org/users/julia_wicker_the_goddess/pseuds/julia_wicker_the_goddess
Summary: “Did you hear what the doctor said,” Her mom asks.She had. He had just told her that her cancer was back.
Comments: 8
Kudos: 23





	1. Familiar Beginnings

“Alexa. Alexa?”

“What?”

“Did you hear what the doctor said,” Her mom asks.

She had. He had just told her that her cancer was back.

“Alexa?”

“Yeah. Yeah, I heard.”

“We need to admit you to the hospital. And I’d like to start the process of finding you a stem cell transplant.” Her doctor says. 

Alexa swallows. She had expected this to be a routine check-up like every other one she’s had since she’s been cancer-free.

At the end of the appointment, she gets up and follows her mom out. She’s silent on the walk out to the car and on the way home to gather things for the hospital. Her mom tries to talk to her in the car, but she doesn’t respond. When they get home, she trudges upstairs and throws a suitcase on her bed, packing blankets, pajamas, and toiletries. When she gets to the bathroom to grab her shampoo and razor, she catches her reflection in the mirror. She glances at her hair, which had just grown long enough to put in a ponytail again. Her eyes wander to her arm, where she still has a scar from the PICC line, through which they gave her IV chemotherapy. She looks up to her lips, where she remembers sores from the chemo that wouldn’t heal for months. And that’s when she starts hyperventilating. She can’t go back; can’t do this again. Tears roll down her cheeks and she crumples to the ground, hugging her knees and leaning against the bathtub.

“Alexa, hey…” Her mom is next to her all of a sudden, holding her shoulders, kissing her forehead, squeezing her cold hands.

“Sweetie, you’re going to be alright.”

“I can’t do this again. I can’t do this again. I can’t do this again.” She repeats it over and over, hoping that somehow that will help the situation. That maybe her mom can make it all go away.

“I’m so sorry.”

Her mom rubs her arms and pats her back while she breaks down in sobs. She stays there until she can finally pull it together. She doesn’t feel better, but she’s run out of tears to cry.

“I know you don’t want to go, but we need to.”

Alexa nods, getting up. She’s numb as she watches her mom finish packing her bag and then they get into the car and drive to the hospital.

  
  


When they arrive, they already have a list of things to do: weight and height, more bloodwork, and meeting with the care team. Alexa is quiet and sullen throughout these. Her care team decides after looking at her veins that she needs a port-a-cath instead of a PICC line. This means she’ll have to go under twilight sedation and have a metal device put in her chest under the skin through which she’ll get medication by putting a needle into the port. It’ll happen in the morning.

She hadn’t had a chance to talk to Katie, and she finally has time when the care team leaves.

**Alexa: Heyyyy. So I’m at the hospital.**

**Katie: What’s going on? Do you want me there?**

**Alexa: My tests came back from my last check-up. The cancer’s back.**

Katie FaceTimes her within seconds.

“Hi.”

“Hi.”

“So… it’s back.”

“Mhm…” Alexa tries to smile, but all of a sudden she’s fighting off tears again.

“Do you want me to come there?”

Alexa nods, sniffling.

“I’ll be there as soon as I can.”

  
  


It’s only half an hour till Katie is marching into the room and practically tackling Alexa in a hug.

“Oh Alexa.”

“Hi.”

“I’m so sorry.”

Alexa nods.

“What’s the plan?”

“They’re gonna put in a port. It’s like my PICC line, but in my chest. Actually, it’ll be nice, because when it’s not in use, we can take the needle out and there’s no infection risk when it’s not accessed. And I can shower normally without having to plastic wrap it, like I did with the port. Then, chemo and finding a match for a stem cell transplant.”

“Okay. We’re gonna get you through this.”

Alexa nods again shakily.  “I… This is my worst nightmare. Before, I didn’t know what I was getting into. Now I do, and…” She lets out a quivering sigh.

Katie nods. “You’re not alone in this.”

“I know. Thank you.”

Katie stays until the nurse forces her to leave. Alexa’s mom is still there, fussing over her. She adjusts her blankets, fixes Alexa’s hair, tidies the already messy bedside table.

“Mom, I’m fine. Really.”

“Are you sure you don’t need another pillow?”

“I’m sure, mom. Please, just sit down.”

Lori finally sits down.

“I guess I’m nervous about tomorrow. But probably not nearly as nervous as you are.”

Alexa nods.

“Can I do anything to help?”

“No. I’m okay.”

That night, she can’t sleep. She’s too cold, then too hot, the kid in the room next to her is too loud. She finally ends up nodding off around 3 in the morning, but has to be up 3 hours later to prep for the surgery. She has to take a shower with special soap and then wear a blue hair cap and gown for the surgery.

She fidgets in bed as they wait for surgery to call down that they’re ready. Her mom keeps asking her if she’s okay, and she keeps saying yes. But then it’s 20 minutes till her call time and she feels like she’s going to throw up, she’s so nervous.

“Alexa, let’s try taking some deep breaths, okay?”

Alexa nods and looks at her mom as she takes a few deep breaths.

“What are you most nervous about?”

“That it’ll hurt. My PICC line hurt so much going in.”

Lori nods. “We’ll make sure you get enough pain meds so it’s manageable, okay? I won’t stop bothering the nurses and doctors until you have what you need.”

“Okay.”

“Are you nervous about anything else?”

“I think just being in the hospital feels scary. I have so many memories of feeling so bad while I was here.”

“That makes sense. Maybe we should see if your counselor could do a virtual visit while you’re here so you could talk about some of those things.”

“Yeah, that’d be good too.”

Her mom holds her hand till she has to leave, and then she’s being wheeled down the hall, into the elevator, and to interventional radiology. Her breaths are fast and she's starting to get panicky. The radiologist introduces himself and then starts pushing something into her IV and she starts getting drowsy.

The next thing she knows, she’s being wheeled out of interventional radiology and into a recovery room. Her mom is there, along with a nurse.

“You did so good, sweetheart,” her mom says. 

“Did they do it? Did they get the port in?” She's drowsy and slurring her speech.

“They did. Do you want to see?”

She nods and her mom points out the bandages on her chest. One has a little heart made out of gauze. She can already feel the pain from it ramping up, but she’s glad at least that she doesn’t remember it being put in.

That night, the pain almost gets out of hand, but Alexa’s mom pulls through as promised and won’t stop bugging her nurses till she gets adequate pain medicine. She gets her first dose of chemo through the port that night as well. They numb the site so she doesn’t feel the needle go in, but it’s weird having an IV coming out of her chest. She knows from experience that she’ll probably start feeling pretty crummy pretty soon and just hopes she can get through it. That night, she keeps the TV on and dozes, trying not to think about how bad she may feel soon.


	2. Chapter 2

**Summary for the Chapter:**

> Alexa starts to experience chemo side effects. Katie wrestles with her friend’s relapse.

Alexa wakes up with her chest sore from surgery. She starts to sit up when the room seems to tilt violently and she feels her stomach lurch. There’s an emesis basin sitting on her bedside table and she grabs it, pausing over it for a moment as saliva pools in her mouth. She wills herself not to throw up, but her body doesn’t listen. In fact, she’s pretty sure it pukes a little _extra_ just to spite her. She feels someone put a cool washcloth on the back of her neck but can’t lift her head yet. It seems like the room is rocking and swaying. 

“Shh, it’s okay.”

“Ughh.”

“I know.”

Alexa knows she’s almost an adult, but her mom’s voice is amazingly comforting. Her cool hands sweeping damp hair off of Alexa’s forehead and holding her arm gently soothe her shaking, shuddering body. 

“You ready to lay back down?”

“N-not yet.”

“Okay.”

Another round of vomiting starts. She feels pain shooting through her chest from her port incision and she moans, putting a hand up to cup around the site as if that will somehow help.

“Are you hurting, hon?”

She just moans again between heaves, but she can tell her mom knows how she’s feeling because she sees her reach and grab the bed remote to call a nurse in. By the time this bout of nausea is over, she’s got tears all down her nose, cheeks, and neck and saliva down her chin. Her mom pulls several tissues from the box on the table and cleans her up.

“I know, baby.”

She wants to lay down and shut her eyes but she’s frozen in pain. Any movement brings sharp pain that seizes her muscles and takes her breath away. 

Her mom somehow understands without her talking and supports her to lay down so she doesn’t have to use her chest muscles as much. She can’t close her eyes or the whole room seems to spin, but she can at least be more comfortable as she stares at the wall. The nurse comes in and Lori quietly asks her for more pain medication and anti-nausea for Alexa. 

At some point, she must fall asleep because then she’s waking up to her arm being squeezed in a blood pressure cuff. 

“Hey Alexa, how are you feeling?”

She’s too tired to respond with anything more than a little sigh. 

“Can I get anything for you?”

“No.” Her voice is raspy and her lips are sticking to her teeth, but she doesn’t want to drink anything for fear it will anger the nausea gods. She drifts back to sleep a few minutes later. 

  
  
  


She wakes again to her mom saying her name and rubbing her arm gently. 

“Alexa, sweetie, Dr Breitweizer will be here soon.”

She opens her eyes, a wave of nausea passing over her before ebbing away. 

“What time is it?”

“A little before 9.”

“AM?”

“Yeah. How are you feeling?”

“Still pretty bad.”

Lori nods, eyebrows pinched together in concern. 

Before long, Dr Breitweizer is entering the room. 

“Hello Alexa.”

“Hi.”

“My nurses tell me you had a rough night.”

“That’s an understatement.”

“It seems like you’re not quite as sick this morning?”

“Yeah, but still nauseous and exhausted.”

“How’s your pain level from your port incision?”

“It’s okay right now. I can feel it, but it’s not killing me.”

“I’m glad to hear that. I’d like to talk about the tests we performed.”

“Okay…”

“It appears the leukemia is in your bone marrow like it was before. Your red blood cell count is low, but not low enough that I’d consider a blood transfusion at this point. We’ll keep monitoring that. Your white count is also low so it’s really important that everyone who comes to visit you is completely healthy. My plan for treatment is aggressive chemotherapy to get you into remission followed by a stem cell transplant provided we can find a match for you. It’s possible a family member could be, or there’s a donor registry where we can try to find one.”

“When can we get tested,” Lori asks.

“You can set up an appointment. It may be a day or two till they can put you on the schedule, but this course of chemo will be between 4 and 6 weeks long, so we have some time to find a donor.”

“Four to six _weeks_?” Alexa repeats the words incredulously. 

“I know it sounds like a lot right now.”

Alexa’s throat constricts and she twists her mouth to keep from crying. 

“Keep hanging in there.”

She nods but doesn’t look at him, afraid she’ll break down. 

  
  
  


Katie has sent Alexa several cute animal videos to try to distract her from her worry and potential symptoms but hasn’t gotten anything back since last night. She spends the day pacing, fidgeting, and cycling between 4 apps on her phone. Her mom had told her not to bother Lori; that Alexa would call or text when she could, but Katie is nervous. _What if the surgery went poorly? What if Alexa’s cancer is going to kill her and she just doesn’t know how to tell Katie?_ She keeps going back to her last text with Alexa as if maybe a new text will magically appear. But nothing comes. It’s summer break and she has the day off from work so there’s nothing to occupy her mind except panic. At around 1, there’s a knock at her door that makes her jump. 

“Katie, it’s mom.”

“Come in.”

Jen comes in and sits on her bed.

“How are you?”

“Um… okay.”

“You seem tense.” 

“I guess I am.”

“Alexa’s probably just feeling crummy from the chemo and needing to rest. She’ll text you when she can.”

“But mom, what if she’s really sick? What if she’s dying?”

“I think it’d be pretty unlikely for that to be happening right now.”

“I _mean_ , what if her cancer is really advanced? What if they can’t help her?”

“Honey, try and slow your breathing down. Let’s take some deep breaths.”

Jen models deep breaths and Katie follows. 

“So you’re pretty anxious about this, huh?”

She swallows and nods.

“It’s okay to be scared. But I also think that you’re trying to predict the future and there’s no way to do that.”

She nods again.

“I think we should focus on something in the here and now. Maybe something we _do_ have control over.”

“Like what?”

“Maybe putting together a little chemo care package for Alexa. I bet you can think of some things that might cheer her up or help her feel a little better while she’s in the hospital.”

“Yeah, I guess.”

“So let’s put some of your nervous energy to use by focusing it on that until you hear from Alexa or Lori.”

“Okay. Thanks mom.”

“Of course.”

  
  


Alexa sleeps most of the day but anytime she’s awake, she’s nauseous. The nurse hangs another bag of chemo around 1pm and she groans.

“Can I get you anything?”

“No. I just haven’t recovered from the last bag yet.”  
“I know. You’re doing amazing.”

  
  


She manages to suck on some ice chips around mid afternoon and has some lemon Italian ice at dinner time but that ends up in the trash can a few minutes later when the nausea hits again. Her body hurts and she’s not sure if it’s a chemo thing or if it’s from laying in bed all day, so near bed time she sits up.

Lori, surprised to see her daughter upright, smiles at her. 

“Hey sweetie.”

“Hey. I think I want to get up and walk around a little.”

“Really? That’s great!”

Alexa gets to her feet and sways a bit. Her mom jumps up to clutch her shoulders. 

“Easy.”

“I’m okay.”

“Alright, just take it slow.”

Lori unplugs the IV pump so it’s running on battery and then Alexa walks out of the room and down the hallway feeling stiff and tired. She passes by rooms she remembers having friends in the last time she was in the hospital for chemo. She makes it to the nurse’s station and spots one of her favorite nurses. 

“I heard you were back, sweetie.”

“Hey Angie.”

“I’m sorry you have to be here again. It’s not fair.”

“Yeah… At least I know what to expect this time.”

“You’ve started chemo again, haven’t you?”

“Yeah. How could you tell?”

“You’ve got that green tint you always used to get.”

“Mhm. I’ve been pretty nauseous.”

“Hang in there sweetie.”

“Thanks.”

She’s a little lightheaded and on her way back to the room she slows, then stops, clutching her IV pole with one hand and her head with the other.

“You okay, Alexa,” her mom asks.

“Just a little dizzy.”

“Alright, do you need to sit down?”

“Um… I don’t think so. I just need a minute.”

“Alright.” 

Lori puts her hand on Alexa’s back. After a couple of minutes and some deep breaths, she finishes walking back to her room and practically collapses into bed. She’s overwhelmed by the idea that she has at least a month of this ahead of her. 

“Delivery for Alexa Mendoza.”

Alex looks up and sees the basket that the orderly is setting on a table by the door.

“Oh! Do you know who it’s from,” Lori asks. 

“I think there’s a card.”

“Want me to read it to you?”

Alexa nods at her mother. 

“‘To Alexa, we are thinking about you and are here when you need us. Hope this care package will bring you a little comfort during chemo. Love, Jen and Katie.’ Oh honey, that’s so sweet. Looks like they got you a fuzzy robe, some of that ginger candy that helped last time on your milder nausea days, some protein bars, a soft beanie, and some earrings.” Lori holds up each item for Alexa to see.

“That’s really nice.”

“Make sure to send them a thank you.”

Alexa nods and grabs her phone from the table. 

**Alexa: Thank you both for the care package. It’s perfect! ❤️**

**Jen: Of course! We love you, Alexa!**

**Katie: Yah! Luv u! Glad to hear from u!**

**Alexa: sry, I’ve been srsly pukey. But it’s a little better tonight.**

**Katie: I’m glad. Lmk if/when you’d be open to a visit.**

**Alexa: will do.**

  
  
  
  
  
  


**Notes for the Chapter:**

> Thanks so much for reading! What do you want to see next in this story?


	3. Chapter 3

**Summary for the Chapter:**

> Alexa continues to deal with side effects: physical and mental. She gets some visits from Katie, Lucas, and Spencer.

Alexa wakes up that night throwing up again. Her mom gets her cool washcloths and clean emesis basins. It’s exhausting and it seems no matter how many anti-emetics the nurses give her, she doesn’t feel better. Sometime in the morning, she finally can sleep again. When she wakes up, it’s to her mom looking serious.

“Hey honey.”

“Hi.”

“How’re you feeling?”

“Really wiped.”

“That makes sense.”

There’s an expectant pause.

“Mom… what is it?”

“Alexa, I think we should talk about college.”

“I’m not ready to go there. I can’t.”

“Alright. But we’re going to have to talk about it at some point.”

“Just… let me feel a little better before I have to think about something else being taken away from me.”

“Alright.”

“Mom?”

“Yeah, hon?”

“Was the nausea this bad last time? I don’t remember it being this bad.”

“Not through the whole time you were in the hospital. But I remember days like this.”

“I think I’ve blocked it out.”

“That makes sense. It was a hard time. It’s sort of like me blocking out your brother’s birth when I decided I wanted another child.”

“Ew, mom.”

Lori smiles at this. It’s relieving to hear Alexa talk playfully. 

  
  


Spencer has been texting her frequently as usual. He’s staying near his college for an internship this summer but they still talk nearly every day. She says she has a stomach bug so he won’t worry about her long lapses in between responses. As she’s sucking on ice chips her third night in the hospital, her mom brings it up. 

“Alexa, does Spencer know you’re in the hospital?”

“No.”

“You’re going to have to tell him eventually.”

“I know… I just remember how hard it was seeing someone else go through what I’d been through. I don’t want to make him relive that fear and pain.”

Lori nods.

“I know I should tell him.”

Lori just looks at her.

“I’ll tell him.”

“Thank god.”

She texts him that they need to talk and 5 minutes later he FaceTimes her. She takes a deep breath and then answers the phone.

“Hey Spencer.”

“Hey. Man, that stomach bug must be kicking your butt. You look like you’re not feeling very good.”

“I’m okay.”

“Where are you? It doesn’t look like your room.”

“That’s what I need to talk to you about.”

“Okay…”

“I’m… I’m in the hospital.”

“Why?”

“My cancer’s back.”

She watches flashes of various emotions come over him before he can finally speak again.

“You’ve got A.L.L. again?”

“Yeah.”

“What part of your body is it in?”

“Just my bone marrow.”

“Okay… that’s good it’s not in your spine or brain.”

“Yeah.”

“What’s the treatment plan?”

“Chemo, then a bone marrow transplant.”

“Do you have a match?”

“No. My family is going to get tested sometime this week.”

“I’ll get tested.”

“Let’s wait and see if one of them is a match first.”

He nods. She can see he’s thinking a mile a minute.

“When did you find out?”

“A couple of days ago.”

“Why didn’t you say something?”

“I wasn’t sure how.”

He nods. “Have you started chemo?”

She nods.

“Any side effects?”

“Killer nausea and some fatigue.”

“I’m so sorry. I wish I could come visit you right now.”

“You wouldn’t want to. I’m kind of useless.”

“I’d still just come hang out with you, keep you company.”

She nods, trying to smile. “Um, I’m really tired.”

“Okay, I can let you go. Keep me posted on how you’re doing.”

“Will do.”

  
  
  
  
  
  


It seems like every time Alexa starts feeling better from the chemo side effects, they’re hanging another bag of chemo. Her mom is getting increasingly worried about her. 

“Honey, you’ve gotta try and eat something.”

“I can’t. I’m sorry, I just can’t.” Her eyes are barely open and she’s taking careful breaths through her nose, trying not to throw up. Her throat is still sore from the last round. 

“Your body needs fuel.”

“My body’s rejecting fuel. I have thrown up everything I’ve eaten for the last… how many days has it been?”

“Four.”

She sighs and runs her hand through her greasy hair. She hasn’t had the energy to shower. 

That evening, she manages to keep down some broth, and the next day she’s able to eat crackers, soup, and some white rice. She sleeps a lot and watches Tik toks on her phone when she feels confident that she won’t throw up if she looks away from the wall. 

On Saturday, Lori finally leaves the hospital for the day. Alexa is thankful for the break from her mother’s hovering. She feels well enough for a visitor and Katie is at the hospital in record time after she texts her. 

“Hey, how’re you feeling?”

“Tired, but a lot better than earlier this week.”

“Good. I brought a couple of games if you’re interested.”

“Yeah, that sounds good.”

They play a few rounds of Uno before Alexa gets fatigued and keeps yawning.

“Hey, do you want to rest?”

“No, but I probably should.”

Katie nods. “Can I stay with you while you nap?”

“Sure, come’ere.”

Katie climbs into bed with Alexa, careful not to get tangled in her IV tubing. She waits till Alexa is definitely asleep before letting the smile drop from her face. Alexa looks  _ bad.  _ She’s pale and has deep circles under her eyes and it’s only been a week of treatment. She’s so scared that this time the cancer will take her best friend away from her. She scrolls on her phone for a long time, not actually paying attention to anything she looks at. A couple of hours later, Alexa lets out a groan.

“Hey,” Katie says.

“Katie. Hey.” Alexa stretches and quickly puts a smile on her face.

“How are you feeling?”

“Um, a little achy, but fine.”

Katie nods. She plays with the hem of the blanket on Alexa’s bed. 

“So… what have you been up to this week?”

“Mostly working at Wired.” She doesn’t mention  _ worrying about you. _ “Do you wanna play another game?”

“Sure.”

They play Jenga and by the end, wood blocks scatter across the room just as a nurse comes in. 

“Hi Katie,” she says sternly.

“Hi Nurse Claudia.”

“Alexa, how are you doing today?”

“Fine.”

“How’s the nausea?”

“Um, still there but not as bad.”

“Dinner’s coming up. Do you want to order something?”

“Sure.” She pulls up the ordering website on her phone. And scrolls through the list. Everything sounds gross to her but she finally orders some soup and crackers. 

“Well, I should probably get headed home,” Katie says.

“Okay. Thanks for coming.”

“Of course.” 

That evening Lucas comes. He flew in from school. He’s barely talked with Alexa since she found out about the relapse; staying quiet during family Facetimes, not really participating.

“Hey Lex.”

“Hey Lucus. Thanks for coming. You know, you didn’t have to fly all this way.”

“I know. I brought you something.”

She opens the bag he hands her and finds a beanie.

“Thanks.”

“It’s satin lined. I remember you saying how everything felt rough on your head when you lost your hair. I thought this could help.”

“That’s… amazing, Lucas. I can’t believe how thoughtful this is.”

“Well, I thought about if I was losing my hair… and what a  _ tragedy  _ that would be, not only for me, but for everyone who gets to see my hair. And I thought this would be a good gift.”

“Hmm, that’s… not quite as heartwarming.”

Lucus shrugs it off and sits down in the chair next to the bed.

“How… how are you?”

“You don’t have to do that.”

“What?”

“Act like I’m sick.”

“Lex, you  _ are  _ sick.”

“I know, but you’re supposed to my big brother. You’re supposed to make fun of the guys I date and call me your kid sister and just…”

“Okay.”

They’re silent for a minute.

“So nurse Claudia still here?”

“Yup, and mean as ever.”

“Yikes, she was a witch the last time I was around.”

“I know.”

They end up playing Yatzee and chatting like they used to for several hours before Lucas goes back to the Mendoza house to sleep. Alexa feels weird when he leaves. She knows her mom would nag her to rest, but she feels wired. She doesn’t really want anyone around; doesn’t want other people’s expectations, hopes, and fears weighing on her along with her own, but she’s lonely too. She ends up texting Spencer at almost midnight. She’s not sure whether she wants him to respond.

**Alexa: You up?**

**Spencer: Yeah. How r u?**

**Alexa: idk. I wish ppl would stop asking me that.**

**Spencer: I remember feeling like that.**

**Alexa: Were you scared? When you were getting treated?**

**Spencer: Of course. Every day.**

**Alexa: We never talked about it.**

**Spencer: That’s because it would have made all of the bad possibilities feel truer.**

**Alexa: Yeah… I guess that’s how I felt too. It was all easier to ignore when I was a kid,**

**though.**

**Spencer: Yeah?**

**Alexa: Like… I didn’t google my cancer. I didn’t google relapse or anything. I just focused**

**on being a kid and let my mom worry about my treatment. Like, sometimes I felt bad, but**

**I still was just focused on getting back to being a kid.**

**Spencer: What are you focused on now?**

**Alexa: I just… keep thinking this is real. This is happening. I could die.**

**Spencer: Hey, you can’t think like that.**

**Alexa: But I could.**

**Spencer: You won’t. Cancer isn’t just a body thing. It’s a brain thing too.**

**Alexa: I know. But I just need a minute to like… be sad. Be scared. I need that to be ok for a minute.**

**Spencer: ok. I’m here.**

Alexa suddenly starts crying. She’s utterly surprised by it, but the sobs take over till she has tears running down her cheeks and neck and she’s out of breath from crying. She realizes it feels good to cry; to admit to herself and someone else how scared she is.

**Spencer: Still awake?**

**Alexa: yeah**

**Spencer: Do you want to Facetime?**

She pauses for a minute. She doesn’t want him to be worried about her. She doesn’t want to take his focus away from his internship. But she also needs all the support she can get. She sniffles and wipes her eyes and nose before pressing the Facetime button.

“Hey,” Spencer says, picking up.

“Hi.” Her voice is still raw.

“Do you want to talk more about it?”

She shakes her head. “Um… tell me how your internship was today.”

“Okay.”

They talk for an hour before Alexa gets too tired to keep her eyes open any longer. There’s something so comforting about talking with someone you love while falling asleep. Even though her cancer is scary, it can’t break their relationship, and that’s enough to let her rest for the night.


	4. Chapter 4

**Summary for the Chapter:**

> Alexa’s chemo side effects continue to wreak havoc on her body till they have to intervene. Katie, Dave and Lori try to manage their own feelings about Alexa’s illness while comforting her.

The next round of chemo starts the next day and Alexa is back to being miserably nauseous. Any time she moves, the room spins and she throws up any sip of water or bit of popsicle that passes her lips. Her mom is getting seriously concerned by day 2 of this when the nurse weighs her and she’s lost nearly 10% of her body weight since the start of her treatment. They’ve been giving her round the clock IV lactated ringers to keep her electrolytes balanced, but she hasn’t had a real, balanced meal since she started chemo. Dr. Breitweizer brings this up the next time he does rounds.

“How are we doing,” Dr. Breitweizer says, coming into the room later that day.

“Dr. Breitweizer, we need to get Alexa’s nausea under control. She hasn’t had a real meal in days.”

“We’ve tried a number medications,” he says, looking through her chart.

“There must be something you haven’t tried.”   
“Well… there is an option now that Alexa’s eighteen. But you may not like it.”

“I think we should try whatever we can.”

“Something many chemo patients find helpful for nausea and vomiting is medical cannabis.”

Alexa struggles not to smile, despite her current nausea. “You want to prescribe me pot?”

Lori looks pensive.

“I guess… if you think it’ll help…”

“How do you feel about it, Alexa? Since you’re an adult now, this is your decision.”

“I’m willing to try anything.”

“Okay. The safest and most effective way for you to take it is using a tincture. Hopefully you’ll be able to keep more down and maybe even have a bit of an appetite.”

They get the results of her family’s tests to see if they’re a bone marrow match for her. Lucas is the only match. When he finds out, he immediately insists on donating bone marrow to Alexa. It doesn’t matter that it will hurt and may affect his college sports since he’ll be weaker and more tired after donating. It’s completely worth it to him. The transplant will happen in several weeks, provided that Alexa’s cancer goes into remission.

The next two weeks, the nurses and her mom heavily push Alexa to drink nutritional shakes as the side effects of the chemo wax and wane. She prefers Ensure Clear because it has less of a chalky texture, but she still can barely stomach them. More of them end up thrown up in the trash than staying in her body although they’re pumping her with antiemetics and she’s taking the cannabis tincture religiously. She’s high as a kite pretty much any time she’s awake, which definitely makes the nausea more tolerable, but it doesn’t decrease her nausea to the point that she can consume as many calories as she needs. 

Katie comes to visit her one day after she’s had a dose of her tincture. 

“Hey Alexa.”

“Katieeee, heeeeey.” Alexa’s pupils are blown and she looks smiley and sleepy.

Katie grins. “How are you?”

“High. I mean, good. Well, both really.”

Yeah, I can tell. Is it helping?” Katie sits down in the chair next to Alexa’s bed.

“Yeah. I’ve thrown up a lot less since starting it.”

“That’s so good. Have you been able to eat?”

“Not a whole lot. The most tolerable thing is clear liquids like tea or slushies.”

“There’s a gas station like a block away. I could grab you a slushie.”

“Um, maybe later? I just want to talk to my best friend.”

Katie nods. “What else is new in the hospital?”

“Megan called. A girl who was just starting treatment when mine and hers was pretty much over is back here and she told Megan.”

“How was that?”

“Good. She gets it.”

Katie nods, looking down. As much as she doesn’t want to admit it, a part of her will always be jealous of the connection Alexa and Megan have that Katie can’t share. But she’s mature enough to realize that it isn’t about her and that Alexa’s relationship with other cancer patients is vital for her.

“I’m glad you could talk to her.”

Alexa nods.

“How are you feeling about everything?”

“Um, I don’t know. It’s weird.”

Katie can tell she’s deflecting and raises an eyebrow. 

“It’s… it’s scary. I feel out of control and… it feels more serious than last time. I mean, it is. My chances of survival aren’t as good as they were before. Both because I’m older and because the cancer is recurrent. I could die. Like, there’s a not-small chance that I could die.”

Katie nods, frowning.

“I’m scared, Katie.”

She can tell that Alexa is being more up front than she would if she were unintoxicated. Katie gets up and scoots into bed next to Alexa, wrapping her arms around her. She can feel her friend’s ribs and it scares her.

“It’s going to be okay. I’ll be here no matter what, but whatever statistic you heard? That’s not you. Whoever took that data didn’t know how strong and brave and amazing you are. You are going to get through this.”

Alexa nods but looks serious. Katie tries to lighten the mood by sharing stories of her brother’s antics and her work at wired. Fortunately, Alexa is easily amused with the pot in her system and laughs so hard she has tears rolling down her face when Katie tells her about her brother’s attempt to dye their dog blue for the Fourth of July. When Katie finally has to go, Alexa is happy but exhausted.

“Get some rest, okay?”

“Alright.” Katie hugs her and leaves.

  
  
  


By the fourth week of chemo they’ve reached a critical point. Even with the tincture Dr. Breitweizer prescribed, she’s lost an unsafe amount of weight and her whole team is concerned. She is too, but she’s not sure what else she can do. She’s exhausted all the time and too nauseous to eat more than a few bites of bland food at a time. After one of an uncountable number of times she’s thrown up, Alexa sees bright red in the emesis basin. 

“Uh, crap.” She presses the nurses’ button and before long, Angie is coming in. 

“Hey hon, what’s up?”

“I just threw up blood.”

The nurse’s eyebrows pinch together and she comes over to look at the pink basin Alexa is holding.

“You certainly did. My guess is you’ve got irritation or a tear in your esophagus from how much you’ve been sick.”

“Is it dangerous?”

“It could be, but probably isn’t. It will hopefully heal on its own. I want you to have a nurse take a look any time this happens. A small amount of blood is okay, but your platelets are pretty low, so it could turn into something more serious.”

“Okay.”

The next time she gets sick, there’s more blood and the doctor runs some labs to check her platelets. They’re low but not critical, but the doctor decides to give her a blood transfusion to be safe. He also makes her NPO (which means no food by mouth) for 24 hours to try and give her esophagus a chance to heal. She actually feels a lot better after the transfusion. She throws up bloody bile a handful of times that night and the next morning, but by afternoon, it’s stopped.

Her mom comes that evening and she knows she has to tell her what had happened or it’ll come out on its own. 

“How are you, sweetie?”

“Uh, I’m okay. I have to tell you something and I need you to stay calm.”

“Okay…”

“I threw up blood a couple of times last night and today.”

“What? Have they checked your platelets?”

She nods. “I got a transfusion last night.”

“Why didn’t someone call me?”

“I told them not to.”

“Why?”

“I didn’t want you to worry. The nurses said it wasn’t a big deal.”

“Needing a blood transfusion isn’t a big deal?”

“Throwing up a little bit of blood isn’t a big deal.”

Lori looks upset but doesn’t say anything. She sleeps at the hospital that night and watches Alexa breathe. She remembers doing this when Alexa was a newborn—she’d stay and watch her, afraid if she left her little girl, something bad might happen. Before, it was fear of sudden infant death syndrome. Now, it’s fear that the cancer is spreading more or Alexa is getting too malnourished to fight it. She feels guilty for leaving the hospital at all, though Alexa has been practically pushing her out the door. 

  
  


The next morning, Dr. Brietweizer comes in for rounds. “Alexa, I think we need some intervention for your weight. Your body can’t fight if you don’t have energy.”

“I’m trying. I’m trying so hard. I just can’t eat anything without being so sick.”

“I know. And that’s why I want to place a feeding tube.”

“What?”

Lori doesn’t protest, just waits for the doctor to say more. 

“We can do a feeding tube that goes through your nose, down your throat and past your stomach to the second part of your small intestine, the jejunum. It’s called a nasojejunal or NJ tube. It’s temporary and we can take it out whenever you don’t need it anymore.” 

Alexa looks down, tears stinging her eyes.

“What if she throws up the tube,” Lori asks.

“We can place it again pretty easily. If that’s a consistent problem, we could consider placing a surgical tube, but it’s best practice to try a temporary tube first and make sure it works.”

“Alexa, I think we need to do this. You’ll feel better when you’re getting proper nutrition. And we need to keep your body strong to fight this cancer,” Lori says.

She shuts her eyes and takes a deep breath.

“Okay.”

“Alright. I’ll have it placed this afternoon.”

  
  


Three hours later, Angie comes in with supplies on a cart. Her mom had gone home at Alexa’s insistence. 

“Hey Alexa.”

“Hi.”

“How’re you feeling today?”

“The same,” she murmurs. She’s staring at her designated spot on the wall try to keep herself from getting sick again.

“Okay. Well, I’ve got your NJ tube. We’re going to start it here and then go to interventional radiology to get it in the right place.”

“Okay.”

The placement isn’t pleasant at all. It makes her nose hurt and bleed and makes her eyes water. Once it’s in, the tube makes her struggle not to gag every time she swallows. But they get it in the right place with the X-ray fairly quickly and then she can go back to her room and rest. She puts her phone in selfie mode so she can look at it. The tube is yellow and comes out from her nose and is taped to her cheek. It then wraps behind her ear and ends a few inches below her shoulder. She looks really unwell. Her eyes are bloodshot and her face is pale. She’s got deep bags under her eyes. She combs her fingers through her messy hair, and a clump of it comes out in her hand. She stares at the brown hair in her palm and bursts into tears. Just then, Dave Mendoza comes through the door.

“Alexa, oh honey, it’s okay.” He opens his arms and she pushes herself into them, crying into his chest. He rubs her shoulder gently and lets her cry. When she calms down somewhat, with a lighter stream of tears trickling down her cheeks, he pulls back to look at her.

“What’s going on?”

“This chemo is kicking my butt. And so is my cancer.”

He nods, looking concerned.

“I’m just so tired.”

“I know, sweetie.”

“And scared.”

“I wish I could take this away. But since I can’t, I want you to know I’m here. I’m not going anywhere. You’re so strong. I know you can make it through this, even if it’s really hard.”

She nods, more tears slipping down her cheeks. 

Her dad holds her till her tears finally run dry. 

“Do you want me to stay here tonight,” Dave asks. 

“No, it’s okay. I’ll be okay. But dad?”

“Yeah?”

“Could you bring your electric shaver next time you come?”

“Of course. I’m hoping to stop by on Sunday.”

She nods.

  
  
  


That night, the nurse starts a bag of formula going into the tube slowly through a pump. It’s another machine attached to her IV pole, one more tube to join her IV lines going to her port, one more machine to wake her in the night with its beeping. She’s not thrilled about it. But she is thankful for it. Now she won’t have to force herself to try and eat when she knows she’ll just throw it back up. And she knows she’ll be getting consistent nutrition to help her body fight. But she doesn’t feel like herself. She’s terrified that this disease and its treatment are stripping away her identity, transforming her into the girl who only talks about her disease, who has no personality apart from ‘the sick girl.’ As she lays in bed, trying to find a position that’s tolerable with how the NJ tube shifts when she’s horizontal, she wonders if that’s what she’s destined for. Part of her wonders if she’ll make it at all.

**Notes for the Chapter:**

> I had an NJ tube for about a month due to chronic illness and now have a surgical feeding tube. It can be a lot to adjust to, but I’m so thankful we have these options and it’s been a real blessing to have an option to stay fed/hydrated. Chronic illness can really affect the way you view yourself and your body and I’m hoping to delve into that deeper in the next chapter. 
> 
> Let me know what you think of this story so far! What would you like to see next?

**Author's Note:**

> Thanks for reading! What would you like to see in the next chapter?


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